Atlanta School of Massage Online Application
Which class start do you prefer?*
Legal Full Name:*
Maiden Name:
City* / State* / Zip:* -
Home Phone:*
Alternate Phone:
E-mail Address:*
Date of Birth:*

Current Occupation:*
Employer's Name:
Employer's Phone:

Have you ever been convicted of a crime?* Yes No

Note: Not disclosing a criminal record may prevent you from becoming licensed.

If yes, please describe:Limit to 1,000 characters  |   characters left

What is your highest level of education?*
Do you intend to ask for
transfer credit consideration?

Note: Does not apply for the Massage Program.

Yes    No

Discount Coupon Code:

Important Notes:
*Misrepresentation of information may result in denial of admission or expulsion.
*After submitting the application, you must be in contact with Admissions within the next 3 business days.
*Applications remain active for 1 year after submission.
*Application fee refundable if requested within 3 days of payment.